Under the direction of the Medical Management Director, the Case Manager/Nurse Navigator Level I serves in an expanded nursing role to identify, evaluate, and implement all options and services with the goals of optimizing the member's health status. Members may have complex, catastrophic, long term illness or injury, Behavioral Health conditions, Pediatric conditions, high risk pregnancy, targeted chronic conditions or be in need of transition of care services. The Case Manage/Nurse Navigator promotes quality, cost-effective outcomes throughout the care continuum, utilizing the nursing process and critical thinking skills to administer all facets of the case management process in the implementation of the nursing plan of care, coordination and oversight of services, and evaluation of service options.

The Case Manager/Nurse Navigator will identify and enroll patients with complex and chronic health conditions and/or refer to other services/programs per policies. The Case Manager will support transitions of care as assigned and/or chronic condition support or health and wellness programs for the assigned population.

Depending upon the primary role, the Case Manager maintains an average of 50-75 complex active cases per month or an average of 75-100 total active cases per month which include a combination of complex and general case management cases. Nurse Navigators for Population Health may maintain larger caseloads of 150-200 patients.

The Case Manager/Nurse Navigator acts as a member advocate, facilitates communication and coordinates care with physicians, the provider's clinic, hospital facilities, family, caregivers and other healthcare providers, and implements creative solutions to meet members' health care needs without compromising quality of outcomes. The position responsibilities also include supporting health risk reduction through behavioral change, patient education and reducing preventable readmission rates by supporting discharge planning to the next level of care and educating and stabilizing the member in their healthcare setting.

Design an individualized plan of care with the patient and fosters a team approach by working collaboratively with the patient, their support system, primary care provider, and other members of the health care team to ensure coordination of services.

Patient support activities performed in this role include but are not limited to: Complex Case Management, High Risk Disease Management, Transition of Care management, Health Promotion, Care Coordiantion and Health Coaching

Implement, evaluate and revise case management treatment plans according to eligibility criteria, contractual guidelines and member's physical and psychological needs throughout the continuum of care.

Note: Some Case Managers may be assigned Transitions of Care patients and will also be responsible to ensure a safe and effective transition from the inpatient setting to the community (e.g. home, rehabilitation, residential treatment services or SNF)

Note: Some Case Managers may be assigned to ACO Nurse Navigation, Maternity, AA/PCA, Behavioral Health or Pediatric patients and will also be responsible to support the specific clinical needs and regulatory requirements for these special health populations.

Note: Some Case Managers may be assigned patients with chronic conditions and will also be responsible to close their assigned patients gaps in care, comply with HEDIS standards and provide motivational interviewing support and educationEngage in ongoing timely professional collaboration and communication with the CHRISTUS Health associate, associate's family and/or caregivers and healthcare providers according to member's healthcare needs to enhance positive outcomes

Coordinate plan of care for high risk/high cost patients or those receiving care through out of network providers, within required governmental and contractual guidelines.

Promotes patient knowledge and behavior change support to members with ongoing chronic conditions or special healthcare needs within the first 7-10 days of initial contact.

Establish and maintain rapport with providers as well as ongoing education of providers concerning appropriate protocols, evidence based guidelines and patient status. Support integrated care for appropriate populations.

Collaborate with other departments as appropriate and required to facilitate the completion of case and health management tasks and goals.

Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and performance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, theref...ore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.